Should centralized histopathological review in penile cancer be the global standard?

Abstract

• Newly diagnosed squamous cell carcinomas (SCC) of the penis, including squamous cell carcinoma in situ (CIS), from biopsy specimens were referred from 15 centres to the regional supra-network multidisciplinary team (Sn-MDT) between 1 January 2008 and 30 March 2011.• Biopsy histology reports and slides from the respective referring hospitals were reviewed by the Sn-MDT pathologists.• The biopsy specimens' histological type, grade and stage reported by the Sn-MDT pathologist were compared with those given in the referring hospital pathology report, as well as with definitive surgery histology.• Any changes in histological diagnosis were sub-divided into critical changes (i.e. those that could alter management) and non-critical changes (i.e. those that would not affect management). Results• A total of 155 cases of squamous cell carcinoma or CIS of the penis were referred from 15 different centres in North-West England.• After review by the Sn-MDT, the histological diagnosis was changed in 31% of cases and this difference was statistically significant. A total of 60.4% of the changes were deemed to be critical changes that resulted in a significant change in management.• When comparing the biopsy histology reported by the Sn-MDT with the final histology from the definitive surgical specimens, a good correlation was generally found. Conclusions• In the present study a significant proportion of penile cancer histology reports were revised after review by the Sn-MDT. Many of these changes altered patient management.• The present study shows that accurate pathological diagnosis plays a crucial role in determining the correct treatment and maximizing the potential for good clinical outcomes in penile cancer. • In the case of histopathology, centralization has increased exposure to penile cancer and thereby increased diagnostic accuracy, and should therefore be considered the 'gold standard' .

Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference

“…3 reported above (20). In 2012, the first results of the network in the East Midlands in UK showed an increase in the number of cases discussed since its formation and a trend towards more conservative surgery (53).…”

“…Moreover, the role of surgery both as post-chemotherapy option and as primary treatment (RPLND) in early stages of disease is commonly recommended, as it is associated with a better outcome (17). A UK experience (20) showed that after histology review, pathology diagnoses significantly changed, with 31% of cases receiving a reclassification. The changes were deemed to be critical in 60.4% cases:…”

Recent Advances in the Management of Penile Cancer: A Contemporary Review of the Literature

“…Despite appropriate treatment, the 5-year survival is only 50% in an overall stage-independent analysis, and only 27% in patients with node-positive disease [ 4 ]. A multidisciplinary approach, preferably in high-volume specialized centers, is therefore imperative for developing an optimal management plan, helping to standardize care and facilitating recruitment to clinical trials [ 5 , 6 ].…”

Should the Care of Penile Cancer be Confined to Centralized Centers of Excellence?

“…In addition to the positive impact of COC on PC management, centralization of histopathological review of PC specimens is beneficial for patient care. Tang et al [8] rereviewed 155 histopathological diagnoses of penile squamous cell carcinoma or carcinoma in situ that were referred for centralized histopathological review in one of the UK PC supranetwork hospitals. Any discrepancy between the referring histopathological diagnosis and the one reported by the supranetwork pathologist was recorded.…”